Surgical resection of recurrent differentiated thyroid cancer: patterns, detection, staging, and treatment of 683 patients

Front Endocrinol (Lausanne). 2023 Dec 6:14:1301620. doi: 10.3389/fendo.2023.1301620. eCollection 2023.

Abstract

Background: Despite improvements in overall survival, the recurrence of differentiated thyroid cancer (DTC) is becoming more common and remains a challenge necessitating accurate reappraisal of the patient. This study aimed to describe the characteristics, reasons, morbidity, and strategies of second operations for DTC.

Methods: This was a retrospective observational study of patients with DTC who underwent a second surgery between June 2008 and June 2021 in the Department of Thyroid Surgery at China-Japanese Union Hospital, Jilin University, P.R. China. All clinical characteristics were recorded, and the analysis was estimated using SPSS.

Results: Second surgeries were detected in 683 patients. The proportion of second operations changed with the update of international guidelines from 2015 (P < 0.001). The true recurrence rate progressively increased from 21.3% to 61.5%. The rate of an "absence of preoperative FNA" or an "absence of intraoperative pathology at first surgery" decreased from 49.8% to 12.7%, while that of a "misdiagnosis of preoperative FNA at second surgery" decreased from 10% to 1.8%. The most common tumor location during the second surgery was the lateral lymph nodes (n = 104, 36.5%), with a median time to relapse of 36 months. Completion of thyroidectomy and lymph node dissection correlated with the second operation.

Conclusion: After 2015, second surgeries were more standardized, the incidence of complications decreased, and real recurrence became the most common reason for a second DTC surgery.

Keywords: morbidity; recurrence; second surgery; surgery; thyroid cancer.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenocarcinoma, Follicular* / pathology
  • Carcinoma, Papillary* / pathology
  • Humans
  • Neck Dissection
  • Recurrence
  • Retrospective Studies
  • Thyroid Neoplasms* / diagnosis
  • Thyroid Neoplasms* / pathology
  • Thyroid Neoplasms* / surgery

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the Jilin Province Science and Technology Development Program (20210402011GH, YDZJ202201ZYTS112); and the Program of Jilin Provincial Finance Department (2021SCZ23, 2022SCZ09), the project of China-Japan Union Hospital (2023CL01).